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General NPI Number Information
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NPI Number | 1487239067
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Entity Type | Organization
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Legal Business Name | MIDWEST INNOVATIVE PAIN MANAGEMENT PC
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Dates
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Enumeration Date | 03/15/2021
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | 2003 ARROWHEAD DR APT 3B
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City | MERRILLVILLE
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State | IN
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Zip | 46410-4952
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Country | US
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Telephone | 414-455-1153
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Fax | 833-523-9918
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Provider Business Mailing Address
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Address Line | PO BOX 31
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City | DYER
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State | IN
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Zip | 46311-0031
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Country | US
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Telephone | 219-440-0135
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Fax | 833-523-9918
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAHER FATTOUH
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Credential | MD
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Telephone | 414-455-1153
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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